Liver Transplant a Safe Option After Recovery From COVID-19

NEW YORK (Reuters Health) – Candidates for liver transplant (LT) who have symptomatic SARS-CoV-2 infection are at high risk of premature death – particularly those with decompensated cirrhosis and a Laboratory Model for End-Stage Liver Disease (Lab-MELD) score of 15 or higher.

However, once patients recover from COVID-19, LT is a safe option with no evidence of SARS-CoV-2 recurrence.

These are the chief findings of the first large cohort of patients who developed COVID-19 while listed for LT.

“Many publications have explored the impact of COVID-19 on patients with chronic liver disease, but no study has focused on patients on the waitlist for LT,” say Dr. Luca Saverio Belli, with ASST Large Metropolitan Niguarda Hospital in Milan, and colleagues in the journal Gut.

Among 113 LT candidates with COVID-19, 37 (32.7%) died after a median of 18 days, with respiratory failure the major cause (89%), they report.

Of note, the death rate in LT candidates with COVID-19 was 49% in those with decompensated cirrhosis and Lab-MELD score of 15 or higher – which is triple the mortality risk observed in listed patients with comparable Lab-MELD scores without COVID-19, the researchers point out.

They say assessing two simple variables – MELD class of 15 or greater or less than 15 and the presence or absence of dyspnea – “allowed a clear distinction between the individual mortality risks on clinical presentation.”

Reassuringly, prior COVID-19 did not affect early post-transplant survival, which was 96% (25 of 26 patients who underwent LT), and, as of publication, no cases of SARS-CoV-2 reinfection have been observed, the authors say.

SOURCE: Gut, online July 19, 2021.

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